Physician communication skills are fundamental to providing high quality palliative care. Recent studies demonstrate that educational interventions designed to improve communication can change physician behavior, as assessed by expert coders. However, to date no studies have examined whether the changes in communication behaviors noticed by expert coders are also noticed or valued by patients and family members. This gap in scientific knowledge is a critical barrier to understanding how improving physician communication skills influences palliative care outcomes for patients with cancer. In preliminary work, we have designed, implemented, and evaluated an intensive 4.5 day communication skills intervention for Medical Oncology fellows, called `Oncotalk'(NCI R25 92055).7 One of the essential communication tasks we teach in Oncotalk that has received little empirical study is Transitions from anticancer therapy to end-of-life care (i.e. shifting goals of care from anticancer treatment to quality of life). We measured communication skill acquisition using pre- and post-Oncotalk standardized patient encounters that were audiotaped and analyzed using a content-based coding system. These pre- and post-Oncotalk audiofiles provide a unique research opportunity to examine the significance of improvements in physician communication skills. In this revision, we elicit patient and family views about transitions conversations before presenting them with pairs of pre- and post-Oncotalk standardized patient encounters from a single physician in random order. We will then ask subjects to choose which encounter represents more effective physician communication, and finally ask subjects to explain the reasons for their choice. The specific aims of this proposal are: 1. To identify and describe key qualities of physician communication skills in discussing transitions to palliative care that are valued by patients and family caregivers. 2. To compare patient and family caregiver evaluations of pre- and post-Oncotalk conversations about transitions with an expert coding system. 3. To identify and describe key qualities of physician communication skills about transitions to palliative care that patients perceive as improved after Oncotalk. Empirically based training in communication skills has the potential to improve patient outcomes, including decreased suffering, improved adherence, and reduced clinician burnout. This proposal will develop a novel method of assessing changes in physician communication that circumvents limitations of existing rating scales and utterance analyses that is patient-centered, and provide a basis for future communication skills interventions that integrate expert, patient, and family perspectives and improve patient outcomes.